Childhood and Mid-Life Antecedents of Adult Self-Neglect

Background and Purpose: Self-neglect (SN) is a pattern of behaviors whereby an individual resists caring for their health, hygiene, and/or home environment. SN is difficult to treat, with poor outcomes and high mortality rates. The qualitative literature indicates SN occurs prior to age 65, yet quantitative studies are typically limited to senior citizens. Overlapping findings from multiple fields imply a lifespan model, in which several childhood factors (among them intrusive/controlling parents and Adverse Childhood Experiences, or ACES) and mid-life characteristics increase SN behaviors. One such mid-life characteristic is personal sense of control, a factor associated with ACEs, intrusive/controlling parents, and SN. The purpose of this study was to assess quantitatively whether ACEs, intrusive parenting, and/or sense of control were related to SN in a sample that included non-elderly adults.

Methods: This secondary analysis used data collected from participants in the Mid-Life in the United States (MIDUS) study’s 2011-14 refresher panel, constituting a nationally representative sample of 2,610 adults ages 25 to 74. The DV was SN, assessed using a measure of how often respondents engaged in care of their home environments, with a response range of 0 (several times a week) to 5 (never). Predictors included the following ACEs: emotional abuse, physical abuse, living with an alcoholic parent, and being separated from a parent. Measures of intrusive parental behaviors included: excessive rules on how to spend time, strictness, prohibition of developmentally appropriate activities, and harsh punishment. Three items measuring sense of control were also included as predictors. Demographic covariates representing marital status, age, and number of household members were included as control variables. Ordinal logistic regression modeling was used to determine the extent to which predictors increased the odds of greater self-neglect as evidenced by higher probabilities of less frequent care of the home environment. Models were assessed for proportional odds, misspecification, and estimated using robust standard errors.

Results: In the best-fitting model (weighted F _{[8, 2339]} = 7.66, p<0.000) severe physical abuse (AOR = 1.08, p< 0.01), harsh maternal punishment (most severe level AOR = 1.55, p<0.05), and low sense of control (AOR = 1.12 p = 0.001) were significantly associated with higher odds of less frequent home environment care, indicative of a higher level of SN. However, no significant effect was found for age or for any interaction terms.

Conclusions and implications: These findings provide preliminary support for a lifespan perspective of SN as both childhood factors and mid-life characteristics were associated with reduced frequency of home environment care. Additionally, the non-significance of age supports the notion that SN is not a phenomenon restricted to the elderly. Consequently, because of the existing research focus on SN in elderly populations, additional research on the antecedents of SN among non-elderly populations is needed as these antecedents occur as early as childhood resulting in SN that can manifest in middle age or earlier. The results also suggest potential opportunities to prevent or treat SN through attachment-based therapy to address consequences of ACES and to foster a greater sense of control.